DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184133

Spot urinary albumin creatinine ratio as a predictor of preeclampsia and dilemma in clinical interpretation

L. Thulasi Devi, Anurag Ravi Nimonkar

Abstract


Background: The objective of this study was to evaluate the efficacy of spot urinary albumin creatinine ratio (UACR) as a predictor of preeclampsia and dilemma faced by clinicians in interpretation of lab values expressed in different units, lack of standardization and its further ramifications in long term follow up and prevention of complications of preeclampsia. Wide variation for estimation of UACR leads to confusion in practice guidelines and its interpretation as single International practical information regarding laboratory measurements, calculation, reporting and interpretation doesn’t exist. This prospective randomized study was conducted in Out Patient Department of Obstetrics and Gynaecology in a tertiary care hospital over a period of 1 year after due clearance was obtained from Ethical Committee.

Methods: This was prospective study involving 400 ladies reporting for Outpatient ANC services within the given time period as per existing guidelines at a tertiary care hospital. Patients were assessed at first booking visit at 18-20 weeks, and thereafter based on clinical and haematological findings, severity of disease more frequently if desired and were admitted in case of imminent eclampsia. The mean age of the patients was 20.5±0.5 and 24.5±0.5 years and treatment duration were till successful delivery and 06 weeks postpartum for persistent microalbuminuria and exclusion of underlying medical cause for Hypertension. Fetomaternal morbidity and mortality was not a criterion of exclusion.

Results: Compared with 24-hour urinary protein excretion, the spot UACR may be a simple, convenient, and accurate indicator of significant proteinuria and future complications in women with preeclampsia with proper and intensive clinical follow up and intervention to prevent feto maternal morbidity and mortality. A strong correlation was evident between spot UACR with high sensitivity and specificity.

Conclusions: UACR measurement is a simple, quick, and reasonably reliable method for prediction and assessment of severity of preeclampsia. Spot UACR correlates better than spot UPCR to 24-hour urinary protein excretion to the severity of disease and as predictor of severity of disease.


Keywords


Clinical interpretation, Predictor, Preeclampsia, UACR

Full Text:

PDF

References


Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Osterman MJ. Births: final data for 2008. Natl Vital Stat Rep. 2010;59(1):3-71.

Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-74.

Villa PM, Kajantie E, Ra¨ikko¨nen K, Pesonen AK, Hämäläinen E, Vainio M, et al. Aspirin in the pre-vention of pre-eclampsia in high-risk women. BJOG. 2013;120(6):773.

Poon LC, Nicolaides KH. Early prediction of preeclampsia. Obstet Gynecol Int. 2014;2014:297397.

Thangaratinam S, Langenveld J, Mol BW, Khan KS. Prediction and primary prevention of pre-eclampsia. Best Pract Res Clin Obstet Gynaecol. 2011;25(4):419-33.

Torrado J, Farro I, Zo´calo Y, Farro F, Sosa C, Scasso S, et al. Preeclampsia is associated with increased central aortic pressure, elastic arteries stiffness and wave reflections, and resting and recruitable endothelial dys-function. Int J Hypertens. 2015;2015:720683.

Ohkuchi A, Hirashima C, Takahashi K, Suzuki H, Matsubara S. Prediction and prevention of hypertensive disorders of pregnancy. Hypertens Res. 2017;40(1):5.

Fagerstrom P, Sallsten G, Akerstrom M, Haraldsson B, Barregard L. Urinary albumin excretion in healthy adults: a cross sectional study of 24-hour versus timed overnight samples and impact of GFR and other personal characteristics. BMC Nephrol. 2015;16:8.

Huang Q, Gao Y, Yu Y, Wang W, Wang S, Zhong M. Urinary spot albumin: creatinine ratio for documenting proteinuria in women with preeclampsia. Rev Obstet Gynecol. 2012;5(1):9-15.

Sarafidis PA, Riehle J, Bogojevic Z, Basta E, Chugh A, Bakris GL. A comparative evaluation of various methods for microalbuminuria screening. Am J Nephrol. 2008;28(2):324-9.

American Diabetic Association: Standards of medical care in diabetes-2009. Diabetes Care. 2009;32(suppl 1):S13-61.

Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al; National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139(2):137-47.

Halimi JM, Hadjadj S, Aboyans V, Allaert FA, Artigou JY, Beaufils M, et al. Microalbuminuria and urinary albumin excretion: French clinical practice guidelines. Diabetes Metabo. 2007;33(4):303-9.

Osberg I, Chase HP, Garg SK, DeAndrea A, Harris S, Hamilton R, et al. Effects of storage time and temperature on measurement of small concentrations of albumin in urine. Clin Chem. 1990;36(8):1428-30.

Brinkman JW, de Zeeuw D, Duker JJ, Gansevoort RT, Kema IP, Hillege HL, et al. Falsely low urinary albumin concentrations after prolonged frozen storage of urine samples. Clin Chem. 2005;51(11):2181-3.

Miller WG, Bruns DE. Laboratory issues in measuring and reporting urine albumin. Nephrol Dial Transplant. 2009;24(3):717-8.

Molitch ME, DeFronzo RA, Franz MJ, Keane WF, Mogensen CE, Parving HH, et al. American Diabetes Association: Nephropathy in diabetes. Diabetes Care. 2004;27(suppl 1):S79-83.

Townsend R, O’Brien P, Khalil A. Current best practice in the management of hypertensive disorders in pregnancy. Integr Blood Press Control. 2016;9:79-94.

Papanna R, Mann LK, Kouides RW, Glantz JC. Protein/creatinine ratio in preeclampsia: a systematic review. Obstet Gynecol. 2008;112:135-44.

Côté AM, Brown MA, Lam E, von Dadelszen P, Firoz T, Liston RM, et al. Diagnostic accu-racy of urinary spot protein: creatinine ratio for pro-teinuria in hypertensive pregnant women: systematic review. BMJ. 2008;336:1003-6.

National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 suppl 1):S1-266.

Adelberg AM, Miller J, Doerzbacher M, Lambers DS. Correlation of quantitative protein measurements in 8, 12, and 24-h urine samples for the diagnosis of preeclampsia. Am J Obstet Gynecol. 2001;185:804-7.

Evans W, Lensmeyer JP, Kirby RS, Malnory ME, Broekhuizen FF. Two-hour urine collection for evaluating renal function correlates with 24-h urine collection in pregnant patients. J Matern Fetal Med. 2000;9:233.

Somanathan N, Farrell T, Galimberti A. A comparison between 24-h and 2-h urine collection for the determination of proteinuria. J Obstet Gynaecol. 2003;23:378-80.

Vassalotti JA, Stevens LA, Levey AS. Testing for chronic kidney disease: a position statement from the National Kidney Foundation. Am J Kidney Dis. 2007;50:169-80.

Brown MA, Lindheimer MD, De Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). 2001;20:321-2.